LETTERS


Pre-analytical errors: a response to an audit of occurrence


I write in response to an article written by Endaf Walters and published in the June issue of The Biomedical Scientist (page 318). The article, and the corresponding research dissertation that Mr Walters presents, offers some valuable data and information in relation to the impact and occurrence of pre-analytical sample collection errors and quite rightly highlights an area of clinical error which is often overlooked and from which we can all learn. However, I must raise concerns with respect to the extrapolation of data and calculation used to deduce potential financial savings and some of the statements made in the article pertaining to the systems and available data within the blood sciences department of Betsi Cadwaladr University Health Board (BCUHB),


Data extrapolation The article uses a pre-analytical sampling error rate based on data from the haematology section at our Bangor site. This is then extrapolated to provide rejection data for blood sciences (haematology and biochemistry) across the three laboratory service sites in the Health Board. The extrapolation assumes that the error rate in biochemistry mirrors that in haematology, and that these data are then mirrored in our other two sites. I consider this to be potentially highly inaccurate as the ‘sample type’ impact of haematology (anticoagulated rather than clotted leading to higher rejections due to clots in sample) and the ‘coagulation’ effect (the need for far more stringent sample volume criteria for coagulation tests resulting in higher short sample rejections) would increase the percentage rejection rate in haematology. Furthermore, the phlebotomy service models across the three sites are very different, with the service in Bangor being far more reliant on non-specialist phlebotomy staff that those in the other two sites.


Fiscal calculations Mr Walters uses a paper (Green F. The cost of poor blood specimen quality and errors in preanalytical processes. Clin Biochem 2013; 46 [13–14]: 1175–9) reporting


US and European data and uses these to calculate the potential fiscal impact, concluding a potential cost to the Health Board of up to £1.8 million per annum. It must be noted that this paper offers data from non-NHS healthcare services and excludes primary care activity, which accounts for 50% of BCUHB blood sciences workload. While it is useful to try to estimate the cost of errors, there is no recognition of the weaknesses in either the data or the costing model.


Statements In the article, Mr Walters makes statements that are inaccurate in relation to BCUHB processes and data, He states that • BCUHB could not provide specific sickness rates for pathology. This is incorrect; as a service we monitor sickness absence monthly and can provide data by staff group, area, or a combination of both.


• There is a lack of training and information available for staff. All staff receive introductory sample labelling training at induction. A review of training records for February 2015 shows that 74% of laboratory-based staff on the site had received training in sample reception in the previous 12 months. Within the Welsh Clinical Portal (an All Wales IT system which supports electronic requesting and reporting) there is a Pathology Handbook with easily accessible, extensive information on laboratory sample requirements and tests, which is accessible to all staff.


• It does not appear that much resource, if any, has been put into reducing pre- analytical blood sampling errors in the past five years. BCUHB, along with other Health Boards in Wales, have been working with the National Welsh Informatics Service (NWIS) over a number of years to develop and implement various IT initiatives to support and improve pathology requesting and results access. These systems, implemented from 2014 onwards, provide electronic requesting and reporting to primary and


secondary care with interactive user information linked to the pathology handbook providing information on sample type required, retest intervals, previous test results and extended requesting, and interpretive support. This has been implemented alongside a new All Wales Laboratory Information System providing a linked-up system that has been heavily supported by BCUHB resources.


I commend Mr Walters in tackling this area of laboratory service risk and it is possible that the errors in the article are borne of inexperience; within his dissertation document there are some key findings in relation to staff perceptions of availability of training and information that we have picked up and are using to develop an awareness improvement process. Rachael Surridge


Blood Sciences Services Manager Betsi Cadwaladr University Health Board


We are grateful to Ms Surridge for her response to Endaf Walters’ article and apologise for any confusion or embarrassment the inaccuracies highlighted may have caused – Ed


Antipodean engagement


The Institute of Biomedical Science is to be congratulated on its continuing efforts to raise the profile of biomedical science and pathology among the general public. In Australia there has been a series of advertisements on prime time television aimed at educating the general public on the important role that pathology plays in healthcare and wellbeing. Some of these advertisements can be viewed online (www.knowpathology.com.au) by clicking on ‘News’ followed by ‘Videos’. Joseph A J Lynd


Enjoy the benefits of Company Membership


Commercial organisations and institutions are invited to join the Institute as Company Members. Join biomedical scientists in working to improve standards and communications in the pathology laboratory field. Company Members can make their views


THE BIOMEDICAL SCIENTIST AUGUST 2016


known through a liaison group. A brochure is available on request to the IBMS office at: 12 Coldbath Square, London EC1R 5HL. Tel 020 7713 0214. Fax 020 7837 9658. Email mail@ibms.org or via the website (www.ibms.org).


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